barrett's%20esophagus
BARRETT'S ESOPHAGUS
Barrett's esophagus is defined as the endoscopic finding in the distal esophagus of proximal-appearing columnar-lined esophagus of at least 1-cm length that is confirmed by histology.
It is considered a premalignant metaplastic condition that usually involves the distal esophagus.
It is postulated that exposure of the esophageal epithelium to acid damages the lining resulting in chronic esophagitis and its healing involves metaplastic process.

Surgical Intervention

  • Appropriate surgical candidates may consider fundoplication to control reflux symptoms
  • Surgical intervention to prevent adenocarcinoma remains unproven

Esophagectomy 

  • Some clinicians recommend esophagectomy for healthy patients with high-grade dysplasia or patients with invasion of the submucosa, lymph node metastasis or failed endoscopic therapy

Considerations for Esophagectomy

  • Esophagectomy is associated with higher morbidity and mortality at low-volume institutions
  • The natural history of high-grade dysplasia is variable and therefore, the decision to perform esophagectomy should be carefully considered
  • Esophagectomy at a high-volume institution may be considered in patients who are fit for surgery with recurrent diffuse high-grade dysplasia that is confirmed by an expert gastrointestinal pathologist
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